RADIOGRAPHIC DIAGNOSIS OF RECURRENCE FOLLOWING RESECTION FOR GASTRIC CANCER.

Abstract

The difficulties and uncertainties in the diagnosis of recurrence following resection for carcinoma of the stomach are only too well known to those concerned with the care of such patients. They are as great for the roentgenologist as for the clinician. The former is confronted not infrequently with a situation wherein clinical evidence is strongly suggestive of recurrent growth, yet his carefully performed gastrointestinal series discloses minimal or no evidence of an abnormality other than surgical alteration of structures. In an attempt to improve this unsatisfactory situation, we decided to collect and analyze our material, evaluate the causes of failure, and search for more accurate radiological methods of recognizing the reappearing carcinoma. Review of the Literature Review of the literature reveals an almost complete lack of specific reference to the roentgen appearance of recurrent gastric cancer. This is surprising when the frequency of gastric carcinoma and its surgical therapy are considered. The only specific reference found is by Fridman in the Russian literature (1 ). Templeton, in his excellent text (2), describes and illustrates several radiographic appearances that gastric recurrences may present: an infiltrating form, a polypoid form, and an annular type reported by Prévôt in which the stomal canal is lengthened and stiffened in association with local obliteration of mucosal pattern. No other pertinent articles were found. The standard multivolumed reference texts on roentgenology and gastroenterology make no specific mention of the problem. Several publications in the recent x-ray literature are concerned with the appearances of the postoperative stomach following various surgical procedures, but the radiographic features of carcinoma in the residual stomach are not included. Material and Methods The dearth of literature despite the frequency of gastric malignant tumors may be explained, at least in part, by the comparative lack of suitable cases. To evaluate the radiographic appearances accurately it is necessary that a postoperative gastrointestinal series be followed within a reasonably short time by exploration of the abdomen by either repeat surgery or autopsy. These conditions greatly diminish the available material. Indeed, McNeer et al. (3), who were interested in the autopsy findings in gastric cancer cases after resections considered potentially curative, had to assemble their material from 11 major New York City hospitals in presenting the data on 96 such cases. At the Francis Delafield Hospital, an institution for the care of cancer and allied conditions, we were able to collect 41 cases fulfilling the requirements described above. In all these cases some type of resection for gastric cancer had been performed, one or more postoperative radiographic examinations had been made, and re-operation or autopsy was carried out, usually within three months of the last x-ray study.